Surgical drill guide

ABSTRACT

A surgical drill guide is disclosed generally comprising a handle connected to an arm, the arm having an end for contacting a bone. The handle has a plurality of non-parallel channels therein for receiving a sleeve at different angles. Once properly positioned, the sleeve can be used to guide a K-wire into the bone, which can then be used as a guide for drilling a tunnel. The various angles allow the surgeon to achieve a range of tunnel lengths. In some embodiments, the guide has a locking mechanism for locking the sleeve in the channels.

RELATED APPLICATIONS

This is a continuation of U.S. patent application Ser. No. 10/365,904,filed Feb. 13, 2003.

FIELD OF THE INVENTION

The present invention relates to an apparatus for performing a drillingprocedure during surgery. More specifically, the invention relates to anapparatus for guiding a drilling member into a bone at a plurality ofpossible angles, achieving a range of tunnel lengths.

BACKGROUND OF THE INVENTION

Today, due to widespread engagement in sports and other physicalactivities, damage to ligaments, cartilage, and tendons in joints hasbecome a relatively common phenomenon. Unfortunately, though this damageoften requires surgical repair, the repair of some of these joints canbe somewhat difficult.

Examples of such ligaments are the cruciate ligaments, the anteriorcruciate ligament (ACL) and the posterior cruciate ligament (PCL). Theseligaments of the human knee cooperate with other ligaments and softtissue to provide static and dynamic stability to the knee joint. Often,the cruciate ligaments are ruptured or torn as a result of physicalactivity and, consequently, various surgical procedures have beendeveloped for reconstructing the ACL and PCL, thereby restoring normalfunction to the knee.

For instance, many times, when a person's ACL and/or PCL issignificantly damaged, the knee joint is repaired by substituting aharvested or synthetic replacement ligament for the damaged one. Inthese cases, the graft ligament is extended across the interior of thejoint and its two opposite ends are anchored to the femur and tibiabones. Typically, these procedures involve forming tunnels in the femurand tibia bones, then extending the ends of the graft ligament, eitherpart way or all the way, through these bone tunnels, and then securingthese ends to the bones, usually by fastening them to either the sidewalls of the bone tunnels or the exterior surfaces of the bones. Onceanchored in place, the graft ligament is able to cooperate with thesurrounding tissues and thereby perform the functions of the damaged ACLor PCL.

In order to perform these procedures, surgeons typically use a drillguide to create the tunnels in the femur and tibia bones. These drillguide devices generally include a handle or other support means forholding the device next to the patient's body. Typically, these drillguide devices also include a “probe” arm having a tip that is adapted tobe disposed within the knee, often at a location next to what isexpected to be one end of the tunnel to be drilled (i.e. the spot wherethe drilling member that drills the tunnel will exit the bone). Usually,a guide sleeve is provided for directing a drill, or a guidewire forlater guiding the drill, into position on the anterior surface of one ofthe bones surrounding the knee joint. This guide sleeve typically hasits axis more or less aligned to intersect with the aforementioned probetip and is generally slidable or variable in position relative to thesupport means.

In operation, these known drill guide devices are used by first placingthe probe tip at or near a predetermined location on the bone. Next, thedrill guide sleeve is adjusted relative to the probe arm so that one endof the guide sleeve is directed toward the appropriate position on theanterior surface of the bone. Once in place, the probe tip and guidesleeve are locked in position relative to each other by various meansknown in the art, as further explained below. Once the guide sleeve isadjusted and locked in position, a guidewire, often known as a K-wire,is slid through the guide sleeve and advanced through the bone. ThisK-wire defines the tunnel drilling axis. When the K-wire is seated inposition on the bone, the drill guide sleeve is unlocked and removed,longitudinally, back along the K-wire. The rest of the drill guidedevice is then removed, leaving only the K-wire. At this point, acannulated drill is slid over the K-wire to drill the tunnel in thebone.

Due to the complex interdependency between the ACL, the PCL, and theother knee ligaments, bones, and tissues, the precise positioning of thegraft ligament relative to the surrounding bones is critical to thesuccessful reconstruction of the knee joint. Specifically, the abilityof the surgeon to precisely control the positioning and formation of thebone tunnels is of particular importance.

Accordingly, as noted above, these drill guide devices typically includea probe arm and a drill sleeve that are angularly displaceable relativeto each other. Examples of such devices are disclosed in U.S. Pat. No.4,672,957 to Hourahane; U.S. Pat. No. 4,722,331 to Fox; U.S. Pat. No.4,781,182 to Purnell et al.; U.S. Pat. No. 5,112,337 to Paulos et al.;U.S. Pat. No. 5,154,720 to Trott et al.; and U.S. Pat. No. 5,163,940 toBourque, U.S. Pat. No. 5,330,468 to Burkhart; U.S. Pat. No. 5,350,383 toSchmieding et al.; U.S. Pat. No. 5,458,602 to Goble et al.; U.S. Pat.No. 5,562,664 Durlacher et al.; U.S. Pat. No. 5,613,971 to Lower et al.;U.S. Pat. No. 5,643,273 to Clark; and U.S. Pat. No. 5,968,050 to Torrie,all of which are hereby incorporated herein by reference.

Typically, the probe arm and the part of the device that holds the drillsleeve, such as a handle, are connected by, or one is mounted on theother with, a mechanism facilitating this relative angular displacement.In most of these devices, this mechanism includes an arcuate piece alongwhich, or through which, another piece can be ratcheted or slid, andsubsequently, tightened or locked in a position where the appropriateangular displacement is achieved. Accordingly, the surgeon is able toguide the drilling sleeve against the anterior portion of the bone at avariety of angles by moving the part of the drill guide holding thesleeve arcuately relative to the probe arm. In this way, the operator ofthe drill guide is able to guide the sleeve against the bone at aparticular desired angle for a particular surgical operation.

One disadvantage of these devices, however, is that they typicallypermit a certain degree of toggling. As a result, the accuracy of thedevice is reduced. However, as noted above, due to the complexinterdependency between the various parts of the knee, precisepositioning of the guidewire is crucial to a successful procedure.

Another disadvantage of these devices is that they tend to be difficultto manipulate. Once the probe arm is positioned on the bone, unnecessarymovement of the device can cause the tip of the arm to change position.Moreover, excessive movement can even result in damage to the knee.Therefore, once the tip of the arm is in position, the surgeon will wantto move the device as minimally as possible while selecting theappropriate angle for the drill sleeve. However, when using theaforementioned devices, it can be difficult for the surgeon, whiletrying to hold the device steady with one hand, to move the drill sleeveportion of the device to the appropriate angle and then hold it steadywhile locking it into position. Moreover, the fact that these devicestypically employ a number of parts similarly increases the likelihoodthat undesired movement will occur while the device is being locked intoposition against the bone.

Another type of device that has been proposed includes a body having aplurality of angularly displaced sockets for receiving the probe, suchas that disclosed in U.S. Pat. No. 4,920,958 to Walt et al, which ishereby incorporated herein by reference. However, this device has thedisadvantage that, once the probe has been inserted into the knee andpositioned on the bone, the angle of the wire guide relative to theprobe cannot be changed without having to withdraw, reinsert, andreposition the probe.

What is desired, therefore, is an apparatus for guiding a drillingmember into a bone that is easy to manipulate. What is further desiredis an apparatus for guiding a drilling member into a bone that reducesundesired movement of the device. What is also desired is an apparatusfor guiding a drilling member into a bone that does not needlesslydamage the patient's knee.

SUMMARY OF THE INVENTION

Accordingly, it is an object of the present invention to provide asurgical drill guide that reduces the amount of toggling experienced bythe device.

It is a further object of the present invention to provide a surgicaldrill guide that facilitates the easy adjustment of the angle for thedrill sleeve, even after the device has been positioned on a bone.

It is yet another object of the present invention to provide a surgicaldrill guide that minimizes the number of parts required to permitvariable angles for the drill sleeve.

To overcome the deficiencies of the prior art and to achieve at leastsome of the objects and advantages listed, the invention comprises asurgical drill guide, including a handle having a plurality of sleevechannels, each channel having an axis, the axes of at least two of thechannels being non-parallel with respect to each other, an arm having afirst end connected to the handle and a second end adapted to contact abone, and at least one sleeve adapted to receive a drilling member, thesleeve being adapted to be inserted into the plurality of sleevechannels in the handle, wherein the angle of the sleeve with respect tothe handle is variable by disposing the sleeve in different ones of theplurality of channels.

In another embodiment, the invention comprises a surgical drill guide,including a handle having a plurality of drill member channels, eachchannel having an axis, the axes of at least two of the channels beingnon-parallel with respect to each other, an arm having a first endconnected to the handle and a second end adapted to contact a bone, andat least one drilling member being adapted to be inserted into any oneof the plurality of drill member channels in the handle wherein theangle of the drilling member with respect to the handle is variable bydisposing the drilling member in different ones of the plurality ofchannels.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a surgical drill guide in accordancewith the present invention.

FIG. 2 is an exposed elevational view of a portion of the handle of thedrill guide of FIG. 1.

FIG. 3A is a partially cross-sectional side view of the lockingmechanism of the drill guide of FIG. 1.

FIG. 3B is a partially cross-sectional side view of the lockingmechanism of FIG. 3A in a different position.

FIG. 4 is an exposed elevational view partially in cross-section of thedrill guide of FIG. 1 during the insertion of a K-wire.

FIG. 5 is an elevational view of the drill guide of FIG. 1 during thewithdrawal of a drill sleeve.

FIG. 6 is a perspective view of a portion of the handle of oneembodiment of the drill guide of FIG. 1.

DETAILED DESCRIPTION OF THE DRAWINGS

The basic components of one embodiment of a surgical drill guide 10 inaccordance with the invention are illustrated in FIG. 1. As used in thedescription, the terms “top,” “bottom,” “upper,” “lower,” “front” and“rear” refer to the objects referenced when in the orientationillustrated in the drawings, which orientation is not necessary forachieving the objects of the invention.

In the embodiment depicted in FIG. 1, a probe arm 20 is connected to ahandle 40. A first end 22 of the arm 20 connects the arm 20 to thehandle 40, while a second end 24 of the arm 20 is adapted to contact abone. In certain embodiments, the end 24 includes a hook 26 for hookingonto a particular anatomical structure, such as, for example, theintercondylar notch. In other embodiments, the end 24 has a mark 27 foraligning the arm 20 with a particular anatomical landmark, such as, forexample, the anterior horn of the lateral meniscus. Mark 27 may compriseany modification of at least one surface of the end 24 that indicates toa surgeon that the arm 20 is in the proper location, such as, forexample, a line etched via chemical or laser means or created with ink.In certain advantageous embodiments, the end 24 includes an aperture 28,such as an open ended hole, which serves as a target for a drillingmember, as is further explained below.

The handle 40 includes a plurality of channels 42 for receiving at leastone drill sleeve 44. At least two of the channels 42 are not parallelwith respect to each other, such that, when the sleeve 44 is disposed inone of the non-parallel channels 42, its longitudinal axis is angularlydisplaced from the longitudinal axis of the sleeve 44 when the sleeve 44is disposed in one of the other non-parallel channels 42. Accordingly, asurgeon using the drill guide device is able to select the angle atwhich to dispose the sleeve 44 in the handle 40.

As shown more clearly in FIG. 2, the sleeve 44 has an inner diameterdefining a hollow space 46 therein. Accordingly, a drilling member 50,such as, for example, a K-wire, can be inserted into the sleeve 44.

In certain advantageous embodiments, a locking mechanism 60 is disposedin the handle in order to secure the sleeve 44 in the channel 42. Asillustrated more clearly in FIGS. 3 a–3 b, in certain advantageousembodiments, the locking mechanism 60 includes a wall member 62 having aplurality of apertures 63 that correspond to the plurality of channels42. The sleeve 44 has a plurality of ridges 64 such that, when the wallmember 62 is in a first position (FIG. 3 a), the wall member 62 isdisposed between at least two of the ridges 64, thereby preventing thesleeve 44 from moving longitudinally along the channel 42, and thus, thesleeve 44 is locked in place. When the wall member 62 is moved to asecond position (FIG. 3 b), the wall member 62 moves out from betweenthe ridges 64 and away from the sleeve 44, such that the wall member 62no longer obstructs the channel 42 and the sleeve 44 is thus free tomove longitudinally therein. In certain advantageous embodiments, abiasing force maintains the wall member 62 in one of these positionsand, in order for the wall member 62 to move into the other position, aforce must be exerted to move the wall member 62 against the bias. Insome embodiments, this bias is achieved via a resilient element 66, suchas, for example, a spring.

In some advantageous embodiments, the ridges 64 are adapted to inhibitlongitudinal movement of the sleeve 44 within the channel 42 in onedirection only. In these embodiments, the sleeve 44 may be inserted intothe channel 42 and advanced therein even when the wall member 62 is inthe first position. In this way, the wall member 62 and the ridges 64create a ratcheting mechanism by which the sleeve 44 can be advancedthrough the channel 42.

Operation of the above described drill guide 10 is illustrated stepwisein FIGS. 4–5. Beginning in FIG. 4, the surgeon begins by inserting thearm 20 into the knee until the hook 26 is disposed against a bone 90.Next, the surgeon moves the wall member 62 into the second position. Incertain embodiments, this is accomplished with an actuator 68, such as,for example, a push button. When the push button 68 is depressed, and apush bar 70 is advanced through the handle 40. The push bar 70 exerts aforce on the wall member 62, thereby moving the wall member 62 againstthe bias created by the spring 66. When this occurs, the apertures 63are aligned with the plurality of channels 42, and thus, the channels 42are not obstructed. The surgeon then selects the angle at which he orshe desires to insert a K-wire 50 into the bone 90 and inserts thesleeve 44 into the appropriately angled channel 42.

Once the sleeve 44 is advanced through the channel 42 to the point atwhich it is positioned against the anterior of the bone 90, the surgeonthen moves the wall member 62 back into the first position. In theembodiment discussed above, this is accomplished by releasing the pushbutton 68. Without the push bar 70 exerting a force upon the wall member62, the spring 66 biases the wall member 62 into the first position.When this occurs, the wall member 62 engages the ridges 64, locking thesleeve 44 in the channel 42. After the sleeve 44 is locked in thechannel 42, the K-wire 50 is inserted into the sleeve 44. The K-wire 50is then advanced into the bone 90 via drilling or tapping.

Referring to FIG. 5, once the K-wire 50 is disposed in the bone 90, thepush button 68 is again depressed, thereby unlocking the sleeve 44, asdescribed above, and the sleeve 44 is withdrawn from the channel 42. Thearm 20 is then removed from the knee, and the drill guide is moved awayfrom the patient' body. Subsequently, a cannulated drill bit (not shown)is placed over the K-wire 50, which guides the drill bit through thebone 90 to create the bone tunnel.

If, during the surgical procedure, the surgeon changes his or her mindwith respect to the angle at which to insert the K-wire 50, the surgeoncan quickly and easily change the angle by unlocking the sleeve 44,withdrawing the sleeve 44 from the channel 42, inserting the sleeve 44into a different channel 42, and relocking the sleeve 44 into the newchannel 42 as described above.

Referring again to FIG. 1, in certain advantageous embodiments, thehandle 40 has a plurality of slots 48 that are in communication with theexterior of the handle 40, each of which is sufficiently wide to allowthe K-wire 50 to pass through it. Each of the channels 42 is incommunication with at least one slot 48. Accordingly, once the K-wire 50has been inserted into the bone 90, and the sleeve 44 has been withdrawnfrom the handle 40, the drill guide 10 can simply be rotated away fromthe K-wire 50 that is still projecting out from the bone 90. As thedrill guide 10 is rotated away from the K-wire 50, the K-wire 50 simplypasses through the slot 48. Subsequently, the probe arm 20 can beremoved from the knee and the drill guide 10 can be back away from thepatient's body without fear of bumping the K-wire 50 while doing so andthereby damaging the K-wire 50 or the bone 90 in which the K-wire 50 isdisposed.

As illustrated in FIG. 6, in some embodiments, the handle 40 may furtherinclude ancillary channels 80. The channels 80, located proximate to thechannels 42, can be dimensioned to receive a K-wire without the use ofthe sleeve 44. Accordingly, if, once the surgeon has inserted a K-wire50 into the bone 90 via the sleeve 44, the surgeon realizes that aK-wire slightly offset from the existing one is desired, the surgeon canaccomplish this by simply inserting a K-wire into the ancillary channel80.

In certain embodiments, similar ancillary channels may be supplied inthe handle to permit separate drilling pins (not shown) to be insertedinto the bone in order to secure the handle to the bone independently ofthe K-wire 50 disposed in the sleeve 44. In this manner, theseadditional channels allow the surgeon to further stabilize the drillguide.

Though a surgeon may have only a single sleeve 44 that he or she uses toinsert into the different channels 42, or a plurality of sleeves 44 allhaving the same inner diameter, in some embodiments, a plurality ofsleeves having different inner diameters may be used. In theseembodiments, while one sleeve would have an inner diameter such that thesleeve is able to receive K-wires of a certain threshold thickness, adifferent sleeve would have a different inner diameter. Accordingly,though the surgeon could use any individual sleeve with any K-wirehaving an outer diameter corresponding to that particular sleeve'sthreshold diameter or smaller, the surgeon could reduce toggling of theK-wire within the sleeve by selecting a sleeve having an inner diameterthat corresponds to the outer diameter of the desired K-wire.Accordingly, the ability to easily insert and remove sleeves asdescribed above also facilitates the selection of sleeves during aprocedure that further reduces toggling of the K-wires.

In other embodiments, instead of using a single sleeve 44 that isinterchangeably disposable into the different channels 42, a pluralityof sleeves 44 may be simultaneously disposed in the plurality ofchannels 42. In these embodiments, even though a surgeon may select theappropriate angle for the bone tunnel after the surgical procedure hasbegun, the surgeon need not bother with inserting and locking the sleeve44 during the procedure, but rather, need only insert the K-wire 50 intothe appropriate sleeve 44. Moreover, such arrangements may beparticularly useful during procedures in which the surgeon changes hisor her mind with respect to the desired angle in the middle of theprocedure. Because each channel 42 already has a sleeve 44 disposedtherein, the surgeon need not withdraw and reinsert, and unlock andrelock, the sleeve 44 during the procedure, which could cause undesiredmovement of the drill guide 10. Accordingly, the drill guide 10, the arm20 of which is already stabilized against the bone 90, and which mayhave even already been used to guide another K-wire 50 into the bone 90,will not experience undesired movement, which could jostle the arm hook26 or the previously inserted K-wire 50.

In some of these embodiments that employ a plurality of sleeves 44simultaneously disposed in the plurality of channels 42, the sleeves 44are connected to each other such that they form a single unit (notshown). With this arrangement, an entire set of sleeves 44 can beremoved from, and a different set of sleeves can be inserted into, theplurality of channels 42 quickly and easily. Such arrangements may beparticularly useful during procedures in which the surgeon changes hisor mind with respect to the desired thickness of the K-wire 50 duringthe procedure. In such cases, the surgeon can quickly withdraw from thehandle 40 a full set of sleeves 44 suited for a particular K-wirethickness and replace it with a full set of sleeves suited for adifferent K-wire thickness. In this manner, toggling of the K-wirewithin the sleeve can be reduced while still maintaining both theversatility of the alternate drilling angle arrangement and theconvenience and safety of not having to switch a single sleeve from onechannel to another.

It should be noted that, while an arrangement employing a sleeve andlocking mechanism is generally desired, other arrangements are possible.For example, in certain embodiments, both the channels 42 and the sleeve44 are threaded. In these embodiments, the sleeve 44 is simply screwedinto the desired channel 42. In certain other embodiments, the drillingmember 50 itself can be disposed into the channels 42.

It should be understood that the foregoing is illustrative and notlimiting, and that obvious modifications may be made by those skilled inthe art without departing from the spirit of the invention. Accordingly,reference should be made primarily to the accompanying claims, ratherthan the foregoing specification, to determine the scope of theinvention.

1. A surgical drill guide, comprising: a handle having a plurality ofsleeve channels, each channel having an axis, the axes of at least twoof the channels being non-parallel with respect to each other; an armhaving a first end connected to said handle and a second end adapted tocontact a bone; at least one sleeve adapted to receive a drillingmember, said sleeve being adapted to be inserted into the plurality ofsleeve channels in said handle and comprising a plurality of ridges; anda locking mechanism adapted to inhibit said at least one sleeve frombeing longitudinally moveable in at least one direction within at leastone of the channels, wherein said locking mechanism comprises a wallmember having a plurality of apertures corresponding to the plurality ofchannels, such that, when said at least one sleeve is disposed in atleast one of the channels and said wall member is in a first position, aportion of said wall member is disposed between at least two of theridges, thereby inhibiting said at least one sleeve from beinglongitudinally moveable within at least one of the channels, and, whensaid wall member is in a second position, said at least one sleeve islongitudinally moveable within at least one of the channels; wherein theangle of said sleeve with respect to said handle is variable bydisposing said sleeve in different ones of the plurality of channels. 2.A surgical drill guide as claimed in claim 1, further comprising adrilling member disposable into the at least one sleeve.
 3. A surgicaldrill guide as claimed in claim 2, wherein said drilling member is ak-wire.
 4. A surgical drill guide as claimed in claim 1, wherein thefirst end of said arm is fixedly attached to said handle.
 5. A surgicaldrill guide as claimed in claim 1, wherein the second end of said armincludes a hook for securing the surgical drill guide to the bone.
 6. Asurgical drill guide as claimed in claim 1, wherein the second end ofsaid arm includes a mark for facilitating alignment of said arm with aparticular anatomical landmark.
 7. A surgical drill guide as claimed inclaim 6, wherein the mark comprises an etched line in at least onesurface of the second end.
 8. A surgical drill guide as claimed in claim6, wherein the mark comprises a visual indicator on at least one surfaceof the second end.
 9. A surgical drill guide as claimed in claim 1,wherein the second end of said arm has an aperture therein for receivingthe drilling member.
 10. A surgical drill guide as claimed in claim 9,wherein the aperture is an open-ended hole in the second end of the arm.11. A surgical drill guide as claimed in claim 1, wherein: said handlefurther has a plurality of slots in communication with an exterior ofsaid handle; and each of the channels in said handle is in communicationwith at least one of the slots.
 12. A surgical drill guide as claimed inclaim 1, wherein said locking mechanism further comprises an actuatorfor moving said wall member from the first position to the secondposition.
 13. A surgical drill guide as claimed in claim 12, whereinsaid actuator comprises a push button.
 14. A surgical drill guide asclaimed in claim 1, wherein said wall member is biased toward one of thefirst or second positions and is moveable against the bias to the otherof the first or second positions.
 15. A surgical drill guide as claimedin claim 14, wherein said wall member is biased by a resilient element.16. A surgical drill guide as claimed in claim 15, wherein saidresilient element comprises a spring.
 17. A surgical drill guide asclaimed in claim 1, wherein said locking mechanism is adapted to bothpermit said at least one sleeve to be advanced, and inhibit said atleast one sleeve from being withdrawn, through at least one of thechannels.
 18. A surgical drill guide as claimed in claim 1, wherein:said at least one sleeve is threaded; and the channels are threaded,such that said at least one sleeve can be screwed therein.
 19. Asurgical drill guide as claimed in claim 1, wherein said at least onesleeve comprises a plurality of sleeves simultaneously disposed in theplurality of channels.
 20. A surgical drill guide as claimed in claim19, wherein said plurality of sleeves are connected to each other.
 21. Asurgical drill guide as claimed in claim 1, wherein said handle furtherhas a plurality of ancillary channels for receiving the drilling memberor another drilling member.